Treib J, Haass A, Pindur G, Treib W, Wenzel E, Schimrigk K
Dept. of Nurology, University of the Saarland, Homburg, Germany.
Eur J Haematol. 1996 Mar;56(3):168-72. doi: 10.1111/j.1600-0609.1996.tb01337.x.
Complications concerning the blood coagulation have been observed repeatedly after administration of highly substituted, high molecular weight hydroxyethyl starch (HES), but it has not been examined as to how intravascular molecular weight and degree of substitution of HES influence platelet number and volume after repeated administration. Thirty patients with cerebrovascular diseases were treated for 10 days with hemodilution. 500 to 1500 ml of HES 200/0.62(n=10), HES 200/0.5(n=10) or HES 40/0.5(n=10) were infused daily. During the first days, the number of platelets was not lowered beyond the dilution effect, but at the end of the therapy the number of platelets had increased in all 3 groups beyond the initial value. Platelet volume was lowered significantly in the 3 groups. HES 200/0.62 caused the largest drop in platelet volume (-10%, p<0.01). A possible explanation could be that HES macromolecules are attached to platelets or are phagocytized by them. The larger platelets are then broken down and, to compensate the loss, more thrombocytes are released. A correlation between the molecular weight of HES and the breakdown rate of the platelets can be suspected, because HES 200/0.62 has the highest intravascular mean molecular weight(121 kD) and the largest effect on platelet volume.
在给予高度取代的高分子量羟乙基淀粉（HES）后，凝血相关并发症已被多次观察到，但尚未研究重复给药后HES的血管内分子量和取代度如何影响血小板数量和体积。30例脑血管疾病患者接受了10天的血液稀释治疗。每天输注500至1500毫升的HES 200/0.62（n = 10）、HES 200/0.5（n = 10）或HES 40/0.5（n = 10）。在最初几天，血小板数量并未降低至超过稀释效应，但在治疗结束时，所有3组的血小板数量均超过初始值而增加。3组的血小板体积均显著降低。HES 200/0.62导致血小板体积下降幅度最大（-10%，p<0.01）。一种可能的解释是HES大分子附着于血小板或被其吞噬。然后较大的血小板被分解，为补偿损失，释放出更多的血小板。可以怀疑HES的分子量与血小板的分解速率之间存在关联，因为HES 200/0.62具有最高的血管内平均分子量（121 kD）且对血小板体积影响最大。
